Medical Homes (PCMH)

The basic premise behind a medical home as a performance based incentive plan is similar to bundled payments, where providers are reimbursed a set amount to manage all aspects of care for a specific condition. However, a recent study (64) over a two year period demonstrated that patients saw a median of two primary care physicians and five specialists working in four different practices. Due to this dispersion of care, a practical barrier to medical home P4P implementation is assigning and rewarding providers for the care of a single patient. This problem has cited a source of incompatibility between P4P and medical homes (82, 125). Yet, multiple authors (65, 176, 319, 323) argue that medical homes may ultimately be a necessary precondition for effective P4P programs. Champlin (15) however argues that medical homes could help expand the role of primary care physicians.

In the midst of these controversies, The National Committee for Quality Assurance (NCQA, 68) and Bridges to Excellence (128) have provided metrics and plans for assigning patients medical homes. These metrics have yet to be critically analyzed and may provide useful insights for the advancement of medical homes.

Medical Homes Literature

(15) Champlin, Leslie. P4P May Boost Role of Primary Care. American Academy of Family Physicians. 2006: 2(3).

Bridges to Excellence, a national program backed by big employers and health plans designed $125 annual bonuses per patient for clinics for doctors who create medical homes for patients.

Article offers brief explanations why this is becoming a relevant issue, including an estimate that medical homes improvements in care coordination can yield $250-300 per patient in healthcare savings within the first year.